Introduction
Atrial fibrillation (AF) represents an important public health problem. Catheter ablation has emerged as effective therapy. Recurrence after ablation is still around 20–40%. The long-term use of anti-arrhythmic drugs (AAD) after AF ablation has been traditionally reported to reduce late AF recurrences; but has never been supported by randomised trials.
Objective
To test if routine continuation of the previously unsuccessful AAD beyond blanking period reduces AF recurrence at one year after AF ablation.
Patients and method
This randomised controlled clinical trial was conducted between January 2013 and January 2015 in Critical Care Medicine Department – Cairo University. Patients with symptomatic, drug refractory AF were enrolled. All patients underwent pulmonary vein isolation ± left atrial ablation according to AF type. The previously unsuccessful AAD was continued for at least 3 months after ablation, after which patients were randomised to either continue or stop that drug. Patients were regularly followed up for at least additional 9 months. The primary endpoint was reduction of AF recurrence. Secondary endpoints included identification of predictors of recurrence and rate of complications.
Results
Thirty-one patients with paroxysmal (80.6%) and persistent (19.4%) AF were enrolled. Pulmonary vein isolation was achieved in all patients. Seventeen patients were randomized to continue AAD (54.8%) beyond blanking period. After 12 months, there was no statistically significant difference of AF recurrence between the two groups (35.3% vs. 21.4%, P=0.46). The same was observed for paroxysmal AF patients (30.8% vs. 8.3%, P=0.32). Persistent AF and early AF recurrence were associated with late recurrence. Only 2 patients had major complications.
Conclusion
Routine continuation of previously unsuccessful AAD did not reduce AF recurrence, over a period of 12 months. Persistent AF and recurrence during blanking period were associated with later recurrence.

Background
Osteoprotegerin (OPG) is considered as a possible link between bone and vascular disease. It is important to establish noninvasive methods for monitoring vascular changes such as biochemical markers of increased risk for cardiovascular disease events such as OPG, as cardiovascular morbidity is high in diabetics.
Aim
The aim of this study was to determine the relationship between coronary artery calcification (CAC) and OPG levels in type 2 diabetic patients in comparison with healthy controls.
Patients and methods
Our study included 45 type 2 diabetic patients without evidence of previous cardiovascular disease (by history and ECG) and 45 healthy age-matched and sex-matched individuals as control. All were submitted to full history, clinical examination, and lab investigations. Serum OPG concentration was measured by an enzyme-linked immunosorbent assay and CAC imaging was performed using noncontrast multidetector computed tomography.
Results
Significant coronary artery calcification score (CACS) (more than 10 Agatston units) was seen in 23 (51.11%) patients. OPG was significantly high in diabetic patients in comparison with controls, with a mean of 12.9±5.7 pmol/l in cases and 8.6±0.5 pmol/l in controls (P<0.001). The CACS was positively correlated with age and diabetes duration. The OPG was positively correlated with fasting blood sugar and diabetes duration. The CACS showed significant positive correlations with OPG.
Conclusion
Increased serum OPG in CAC that could be used for the early diagnosis of subclinical atherosclerosis allows for designing strategies to reduce the cardiovascular event rates in these patients. Further studies are important to establish the predictive value of increased OPG levels in diabetic vascular complications.

Background
A cancer stem cell model was proposed for bladder carcinoma, as there is a subpopulation of tumor cells capable of resisting conventional therapies and surviving treatment to facilitate recurrence and metastasis. Oct-4 is a pluripotency marker of stem cells, which has been found to be associated with worse prognosis in multiple somatic tumors.
Aim
We aimed to explore the expression of Oct-4 protein in urothelial carcinoma and some of its variants and also determine whether Oct-4 expression and level of expression are associated with the clinicopathological parameters such as age, sex, grade, stage, morphology, and tumor progression.
Patients and methods
We tested 84 urothelial tumor specimens including all grades, stages, and some variants of urothelial carcinoma for the expression of Oct-4. Two sections were prepared per case for histologic evaluation and immunohistochemical staining by Oct-4 monoclonal antibody. The immunostaining was evaluated semiquantitavely through obtaining an H-score for each case.
Results
All cases took up the Oct-4 stain except for low-grade tumors and carcinoma in-situ cases. The highest percentage of positive cases was seen in invasive urothelial carcinoma with variant morphology other than conventional (19.1%). Presence of Oct-4 expression was significantly associated with grade (P=0.03), histopathologic type of urothelial tumor (P<0.001), category (P<0.001), and tumor progression (P=0.001). Conversely, the level of Oct-4 expression among positive cases was not found to be associated with any of the studied parameters.
Conclusion
Our study calls for considering Oct-4 as a novel marker of prognostic significance that could be implemented in target therapies for urothelial carcinoma.

Introduction
Catheter ablation has emerged as effective therapy for AF. Ablation of AF is often a complex and long procedure requiring long fluoroscopy time. An important complication of AF ablation is the delayed effect of the radiation received by the patients and operator.
Objective
We conducted this prospective observational cohort to study factors associated with long fluoroscopy time during catheter ablation of AF.
Patients and Method
This is a prospective observational cohort study, conducted between January 2013 and January 2014 in Critical Care Medicine Department – Cairo University. Patients with symptomatic, drug refractory AF were enrolled. All patients underwent pulmonary vein isolation ± left atrial ablation according to AF type. All operators performed at least 50 previous AF ablation procedures. Clinical (AF type and LA geometry and diameter), and technical (Mapping system and catheters) variables were recorded for each patient. The primary endpoint was to identify variables associated with long fluoroscopy time. Secondary endpoints included identification of complications.
Results
Thirty-one patients with paroxysmal (n=25) and persistent (n=6) AF were enrolled. Pulmonary vein isolation was achieved in all patients. Average fluoroscopy time was 54.2 ± 31.7 mins. We found that the use of CARTO3® system was associated with significantly shorter fluoroscopy time compared to NavX EnSite Velocity® system (48 ± 29.8 vs. 78 ± 27.9 mins, P = 0.02). Using 20-pole circular mapping catheter was also associated with shorter fluoroscopy time as opposed to 10-pole one (47.6 ± 23.2 vs. 98.8 ± 48.4 mins, P = 0.03). Only two patients (6.4%) suffered major complications; major groin bleeding and pericardial tamponade.
Conclusion
The use of CARTO3® navigation system and 20-pole circular mapping catheter seems seems to be associated with shorter fluoroscopy time than EnSite Velocity® navigation system and 10-pole circular mapping catheter.

Mature cystic teratoma with neurogenic components and struma ovarii: a rare case report and review of the literature

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Seema DayalDOI:10.4103/kamj.kamj_17_17

Mature cystic teratoma of the ovary is a common germ cell tumor among women. Teratomas are more frequently seen in younger women. In teratoma, all three germ cell layers are present, and hence any type of histological tissue can develop. As regards the type of tissue present, it may be mature or immature. In monodermal teratoma, one of the tissues may predominate, such as thyroid tissue in struma ovarii and neuroectodermal tissue in carcinoid tumor. Here, we present a case report in which a young woman presented with ovarian mass diagnosed histopathologically as mature ovarian teratoma having mostly neurologic elements such as glial tissue, melanotic cells, choroid plexus, and struma ovarii, and along with that fat and respiratory epithelium were also identified. Ovarian teratoma is composed of derivatives of three germ cell layers, but in some cases monodermal component such as struma ovarii can be seen with neurogenic components and mesodermal components.